Application to Register As EREPS System User

Application to register as EREPS system user

(applicable from 2012 onwards)

Panel A - Personal details. To be completed by the applicant. All fields are mandatory Please use Block Capitals.

I wish to apply to the Department of Agriculture, Food and the Marine

�to be registered as a full user of the eREPS System

�to be registered as a temporary user of the eREPS system from ______to ______.

�To be registered as a user on the test system.(see note at end of second page)

Applicant’s Declaration

I hereby apply to be registered with the Department of Agriculture, Food and the Marine as specified above.

I acknowledge that the data to which I will have access is confidential and is covered by the Data Protection Acts 1998 and 2003. I understand that this information is made available to me for the purposes of submitting REPS/AEOS applications forms online on behalf of my clients. I undertake to use the information solely for the purposes for which it is intended and not to disclose it to third parties.

I confirm that I will keep my log-on details confidential and will not disclose them to a third party. I confirm that the information on this form is correct to the best of my knowledge and that it refers to me.

Signed ______Date: ______

Please return this form to
REPS Section,
Department of Agriculture, Food and the Marine,
Johnstown Castle Estate,
Wexford,

Agency Details. Please complete Panel B or C below and sign the declaration at Panel D. This page is to be completed by the company manager/administrator

Note: A person approved as a test user may be transferred to a temporary or full user by filing out the first page of this form and returning it to

For Official Use only – REPS Division
Username Assigned
Planner/Agency No. Verified / Login Assigned
Date letter/email issued to Planner / Level of Access
Registered by
Date Registered